PCOS and fertility – your questions answered

Polycystic ovary syndrome (PCOS) is a relatively common condition that affects how a woman’s ovaries work and how her eggs are released. Irregular periods are a symptom of PCOS and can indicate the reason for infertility. 

Arpita Ray, Bourn Hall Essex
Arpita Ray, Regional Lead Clinician for Bourn Hall Essex

Symptoms of PCOS 

Women with PCOS often have a hormone imbalance, particularly abnormal levels of insulin – the hormone that controls sugar levels in the body – and higher levels of testosterone, the ‘male’ hormone.

This can cause the following:

  • Irregular periods – ovaries do not release eggs regularly (ovulation)
  • Excess body hair and acne
  • Polycystic ovaries – where the follicles fill with fluid

Women with PCOS often find it difficult to maintain a healthy Body Mass Index (BMI), which in turn can have an impact on fertility, because being overweight or underweight affects the amount of insulin your body produces.

PCOS and egg production 

A human female is born with all the eggs she will ever have and they are contained in small follicles in the ovaries. This is called the ovarian reserve (egg store).

After puberty, follicles are ‘recruited’ from this ovarian reserve and then undergo about three months of growth and development before ovulation (egg release). At the start of each month, there are around 15-20 follicles which have made it to the final stage of this process.

Under normal circumstances, only one of these follicles will become dominant and be exactly the right size, at the right time, to finally release its egg.  One egg will be released each month, and if it isn’t fertilised ovulation will be followed by a period.

However for women with PCOS there is a hormone imbalance so lots of follicles develop and the eggs are not released. Instead the lining of the uterus thickens until eventually it is lost in a bleed.

A regular menstrual cycle is therefore a good indication that you are ovulating.

How PCOS impacts fertility 

Bourn Hall has been offering fertility treatment for 40 years and is the world’s first IVF clinic. It was set up by the IVF pioneers Steptoe, Edwards and Purdy.

When they started their research very little was known about fertility health or about the impact of the hormones on ovaries. Much of this knowledge and the medication to treat infertility has been developed here at Bourn Hall.

Dr Arpita Ray, Regional Lead Clinician at Bourn Hall, and Angela Attwood, Nutritional Therapist for Bourn Hall and founder of Love Nutrition, discuss the impact of PCOS on fertility and how good nutrition can improve fertility. 

PCOS impact on fertility

Dr Arpita Ray, Lead Clinician, Bourn Hall

Dr Arpita Ray is a Consultant Gynaecologist and Fertility Specialist at Bourn Hall. She has an extensive research background in polycystic ovary syndrome and unexplained infertility. At the Bourn Hall clinic in Wickford she has introduced a patient centred approach that includes support for improving fertility health and wellbeing.

PCOS and how nutrition can help

Angela Attwood, Nutritional Therapist for Bourn Hall and founder of Love Nutrition

Angela was first introduced to nutritional therapy as a patient, to help her recovery from cancer treatment. Having seen the benefits she studied to become qualified and has built up a practice helping people struggling with their hormonal health, which includes fertility, digestion and weight management.

PCOS and fertility questions

In the discussion we asked the following questions:

– How is PCOS diagnosed? [0:16]
– PCOS affects ovulation (the release of eggs) – how can someone at home check they are ovulating? Are kits useful? [2:50]
– Are there other causes of an irregular cycle? [6:05]
– How long does it take for a woman’s cycle to recover after stopping contraception? [12:40]
– Not all women with PCOS are overweight, are there different types of PCOS? [7:45]
– In the video you talk about lifestyle changes – how long would it take for lifestyle changes to have an effect?
– Do patients with PCOS need IVF or are there other treatments? [13:30]
– PCOS is related to high levels of insulin – what does insulin do? [9:40]
– How can you improve your insulin levels with good nutrition?

 – Are there other things that can help (sleep, stress)? [6:50]
 – Can you give an example of a patient that you have helped? [10:55]
 – Taking a typical day – what would you recommend someone with PCOS ate for each of their three meals? [17:00]
 – Are there foods that someone with PCOS should avoid? [18:25]
 – Can you help people with lean PCOS? [25:40]
 – What is the optimum BMI for successful fertility treatment, is there a maximum for IVF? [27:10]
 – Is there a risk that women with PCOS can over stimulate during treatment (OHSS)? [29:10]
 – If you get pregnant with PCOS are there any risks for the baby? [24:00]
 – What messages do you have for anyone who is concerned about their fertility? [35:20]

You can see the answers in this video from the webinar.

Questions answered by Dr Arpita Ray, Regional Lead Clinician at Bourn Hall, and Angela Attwood, Nutritional Therapist from Love Nutrition, facilitated by Rachel Holdsworth. (Note: The video is 40 mins long, you can use the time codes above to make it easier to find the answers to specific questions.)

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